耳鏡檢查正常之傳音性聽障的鼓室探查術結果

背景：檢耳鏡下為正常的耳膜和中耳無可視性異常的傳音性聽力障礙的原因很多，往往要靠鼓室探查術來確定原因。本研究對此類患者術前的臨床評估和手術結果作分析探討。方法：回溯病歷1986年9月到2009年8月，挑選檢耳鏡下為正常耳膜且中耳無可視性異常，純音聽力檢查為傳音性聽障的病人，排除有明顯耳部外傷病史、過去耳朵曾接受過任何手術處置的病人。研究其性別、年齡、聽損程度、術前鼓室圖、影像學檢查及手術發現。結果：共45名病患，47次手術。47次手術中有2名為接受雙側手術患者。男女比為26 : 19，平均年齡28.6 ± 14.0歲，右耳左耳比為28 : 19。總平均術前純音聽力閾值58.5 ± 14.7 dB HL。鼓室圖以type A為21耳最多。手術發現造成傳音性聽障的原因歸為五類：耳硬化症22耳（46.8%），中耳炎後遺症10耳（21.3%），先天性膽脂瘤8耳（17.0%），先天性中耳構造異常4耳（8.5%）和聽小骨關節脫位3耳（6.4%）。中耳炎後遺症和先天性膽脂瘤共18耳中17耳有聽小骨缺損，缺損位置多位於砧骨長突和鐙骨。先天性中耳構造異常的術前聽力閾值72.1 ± 4.3 dB HL，聽損是5組中最大的，其中3耳合併缺乏卵圓窗。結論：檢耳鏡下外觀為正常的耳膜和中耳無可視性異常卻有傳音性聽障的原因，經鼓室探查術發現，以耳硬化症原因最多，其次為中耳炎後遺症和先天性膽脂瘤造成。而術前聽力為較大聽損超過70 dB HL時要考慮先天性中耳構造異常。

關鍵字

傳音性聽障；鼓室探查術；耳硬化症；慢性中耳炎；先天性膽脂瘤

並列摘要

BACKGROUND: Causes of conductive hearing loss with normal otoscopy are usually confirmed by exploratory tympanotomy. We provided our experience of the results of exploratory tympanotomy and pre-operative diagnostic methods in patients who had conductive hearing loss with normal otoscopy.MATERIALS AND METHODS: We studied patients who received exploratory tympanotomy due to conductive hearing loss with normal otoscopy by the same surgeon between 1986 and 2009. Those who had definite traumatic history or received any ear procedures were excluded. We analyzed patient's gender, age, degree of hearing loss, pre-operative tympanogram, imaging, and findings of operation.RESULTS: A series of 47 ears of 45 cases over a 23-year period were reviewed. Twenty six cases were male and 19 were females. The average age was 28.6 ± 14.0 years. Pre-operative pure tone tympanometry (PTA) showed average of 58.5 ± 14.7 dB HL. Tympanogram displayed mostly type A (21 ears). The causes of conductive hearing loss with normal otoscopy confirmed by operation could be classified into 5 categories: otosclerosis (22 ears, 46.8%), complication of otitis media (10 cases, 21.3%), congenital cholesteatoma (8 cases, 17.0%), congenital middle ear abnormalities (4 cases, 8.5%), and ossicular dislocation (3 cases, 6.4%). Almost all cases (17/18) of otitis media and congenital cholesteatoma had ossicular chain deformity. The common deformity sites were at long process of incus and stapes. Three out of 4 congenital middle ear abnormalities had absence of oval window. These patients had most severe hearing loss, about 72.1 ± 4.3 dB HL.CONCLUSION: The most common finding in exploratory tympanotomies of conductive hearing loss with normal otoscopy was otosclerosis. It is followed by otitis media-related complications and congenital cholesteatoma. Congenital middle ear abnormalities should be considered when patients demonstrated more severe hearing loss.

並列關鍵字

conductive hearing loss ； exploratory tympanotomy ； otosclerosis ； chronic otitis media ； congenital cholesteatoma

國際替代計量

耳鏡檢查正常之傳音性聽障的鼓室探查術結果

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